Oral Anticoagulants in Atrial Fibrillation Patients With Recent Stroke Who Are Dependent on the Daily Help of Others Article Swipe
Louisa Meya
,
Alexandros A. Polymeris
,
Sabine Schaedelin
,
Fabian Schaub
,
Valerian Altersberger
,
Christopher Traenka
,
Sebastian Thilemann
,
Benjamin Wagner
,
Joachim Fladt
,
Lisa Hert
,
Sohei Yoshimura
,
Masatoshi Koga
,
Annaelle Zietz
,
Tolga Dittrich
,
Urs Fisch
,
Ḱazunori Toyoda
,
David Seiffge
,
Nils Peters
,
Gian Marco De Marchis
,
Henrik Gensicke
,
Leo H. Bonati
,
Philippe Lyrer
,
Stefan T. Engelter
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.120.033862
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1161/strokeaha.120.033862
Background and Purpose: Data on the effectiveness and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with stroke attributable to atrial fibrillation (AF) who were dependent on the daily help of others at hospital discharge are scarce. Methods: Based on prospectively obtained data from the observational Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-longterm registry from Basel, Switzerland, we compared the occurrence of the primary outcome—the composite of recurrent ischemic stroke, major bleeding, and all-cause death—among consecutive patients with AF-stroke treated with either VKAs or DOACs between patients dependent (defined as modified Rankin Scale score, 3–5) and patients independent at discharge. We used simple, adjusted, and weighted Cox proportional hazards regression to account for potential confounders. Results: We analyzed 801 patients (median age 80 years, 46% female), of whom 391 (49%) were dependent at discharge and 680 (85%) received DOACs. Over a total follow-up of 1216 patient-years, DOAC- compared to VKA-treated patients had a lower hazard for the composite outcome (hazard ratio [HR], 0.58 [95% CI, 0.42–0.81]), as did independent compared to dependent patients (HR, 0.54 [95% CI, 0.40–0.71]). There was no evidence that the effect of anticoagulant type (DOAC versus VKA) on the hazard for the composite outcome differed between dependent (HR dependent , 0.68 [95% CI, 0.45–1.01]) and independent patients (HR independent , 0.44 [95% CI, 0.26–0.75]) in the simple model ( P interaction =0.212). Adjusted (HR dependent , 0.74 [95% CI, 0.49–1.11] and HR independent , 0.51 [95% CI, 0.30–0.87]; P interaction =0.284) and weighted models (HR dependent , 0.79 [95% CI, 0.48–1.31] and HR independent , 0.46 [95% CI, 0.26–0.81]; P interaction =0.163) yielded concordant results. Secondary analyses focusing on the individual components of the composite outcome were consistent to the primary analyses. Conclusions: The benefits of DOACs in patients with atrial fibrillation with a recent stroke were maintained among patients who were dependent on the help of others at discharge. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03826927.
Related Topics
Concepts
Medicine
Atrial fibrillation
Modified Rankin Scale
Hazard ratio
Stroke (engine)
Internal medicine
Proportional hazards model
Confounding
Vitamin K antagonist
Observational study
Propensity score matching
Cardiology
Confidence interval
Warfarin
Ischemic stroke
Ischemia
Mechanical engineering
Engineering
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1161/strokeaha.120.033862
- https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.033862
- OA Status
- bronze
- Cited By
- 7
- References
- 35
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3184340472
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W3184340472Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/strokeaha.120.033862Digital Object Identifier
- Title
-
Oral Anticoagulants in Atrial Fibrillation Patients With Recent Stroke Who Are Dependent on the Daily Help of OthersWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-07-27Full publication date if available
- Authors
-
Louisa Meya, Alexandros A. Polymeris, Sabine Schaedelin, Fabian Schaub, Valerian Altersberger, Christopher Traenka, Sebastian Thilemann, Benjamin Wagner, Joachim Fladt, Lisa Hert, Sohei Yoshimura, Masatoshi Koga, Annaelle Zietz, Tolga Dittrich, Urs Fisch, Ḱazunori Toyoda, David Seiffge, Nils Peters, Gian Marco De Marchis, Henrik Gensicke, Leo H. Bonati, Philippe Lyrer, Stefan T. EngelterList of authors in order
- Landing page
-
https://doi.org/10.1161/strokeaha.120.033862Publisher landing page
- PDF URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.033862Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
-
https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.033862Direct OA link when available
- Concepts
-
Medicine, Atrial fibrillation, Modified Rankin Scale, Hazard ratio, Stroke (engine), Internal medicine, Proportional hazards model, Confounding, Vitamin K antagonist, Observational study, Propensity score matching, Cardiology, Confidence interval, Warfarin, Ischemic stroke, Ischemia, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
7Total citation count in OpenAlex
- Citations by year (recent)
-
2023: 3, 2022: 2, 2021: 2Per-year citation counts (last 5 years)
- References (count)
-
35Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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